title: [Palliative care in delivery room for preterm infants less than 24 weeks of gestation. Analysis of two different behaviors].
abstract: OBJECTIVE
  To describe the management of extremely preterm newborns at the threshold of viability before 24 weeks of gestation in the delivery room when the decision has been made not to provide intensive care; to assess the role of palliative care (PC); to report the problems encountered.
  
  
  METHODS
  A prospective qualitative study was conducted using semi-structured interviews from November 2009 to June 2010 in two level III French maternity hospitals (A and B). In each center, four midwives, two obstetricians, two pediatricians, two anesthetists, and one chief midwife were interviewed.
  
  
  RESULTS
  In maternity hospital A, a protocol was in place that proposed PC derived from developmental care (noise limitation, drying, warming) provided by parents or staff. The problems reported were related to former euthanasia practices rather than new procedures. In maternity hospital B, no palliative care protocol had been set up. Euthanasia was practiced and accepted fatalistically because the only currently existing alternative (letting the infant die) was considered inhumane. Few problems were reported. The reluctance to carry out PC is conceptual and organizational (the ratio of births per midwife in maternity hospital B was twice that of maternity hospital A). Lexical analysis showed preferential use of the words "fetus" and "expulsion" versus "child" and "delivery" in maternity hospital B (p<0.05) when speaking of the delivery of the extremely preterm infant. Our explanatory hypothesis is that the concept of "fetus ex utero" legitimates euthanasia by assimilating it to feticide.
  
  
  CONCLUSIONS
  At the time of this study, two very different approaches to the death of extremely preterm, non-resuscitated newborns in the delivery room coexisted in France. Palliative care is obviously possible, after group reflection, if a true motivation to change, a better understanding of the law, and a clear identification of the respective status of the fetus and the newborn exist in the maternity hospital.
authors.affiliation: Service de réanimation néonatale, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France.
authors.forename: M
authors.initials: M
authors.lastname: Pierre
authors.forename: I
authors.initials: I
authors.lastname: Plu
authors.forename: C
authors.initials: C
authors.lastname: Hervé
authors.forename: P
authors.initials: P
authors.lastname: Bétrémieux
mesh_terms: D001291:Attitude of Health Personnel; D003696:Delivery Rooms; D004992:Ethics, Medical; D005260:Female; D005602:France / Q000453:epidemiology; D006771:Hospitals, Maternity; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000523:psychology / Q000706:statistics & numerical data; D008880:Midwifery / Q000706:statistics & numerical data; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires